Keven Peterson, 1835P0018X

Primary specialty

PharmacistTaxonomy code 183500000X

License

RPH-0014096 Issued in OR

Practice address

2490 NE Highway 99W
McMinnville, OR 97128-9204

Phone

(503) 435-3125

Fax

(503) 435-3128

NPI assigned

Aug 5, 2015

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Safeway Inc

  • Community/Retail Pharmacy
  • McMinnville, OR
  • NPI 1114956158
  NPD (past)
• Safeway Inc

  • Community/Retail Pharmacy
  • Queen Creek, AZ
  • NPI 1730040973
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1438732800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1450915200000",
    "number": "1194101873",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1655 NW 23RD ST",
            "city": "MCMINNVILLE",
            "state": "OR",
            "postal_code": "971286601",
            "telephone_number": "503-857-0677"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2490 NE HIGHWAY 99W",
            "city": "MCMINNVILLE",
            "state": "OR",
            "postal_code": "971289204",
            "telephone_number": "503-435-3125",
            "fax_number": "503-435-3128"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "KEVEN",
        "credential": "1835P0018X",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-08-05",
        "last_updated": "2015-12-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "OR",
            "license": "RPH-0014096",
            "primary": true
        },
        {
            "code": "1835P0018X",
            "taxonomy_group": "",
            "desc": "Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
            "state": "OR",
            "license": "RPH-0014096",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHARMACY",
            "identifier": "RPH-0014096",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Janice A Perciano
• Diego Thomas Perez-Campos, RD
• Genesis Perez
• Kenn Peters
• Betty Ilene Peterson
• David Fink Pfendler, MD
• Erica Phelps
• Maria Phillips
• Sydney Rose Phillips
• Physicians Medical Center P C

• Pharmacist in McMinnville, OR
• Providers in McMinnville, OR by specialty
• Pharmacist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 24, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.